COVID-19 in Children with Cancer and Continuation of Cancer-Directed Therapy During the Infection

Abstract

Objective To report the experience with COVID-19 in children with cancer at the largest tertiary-cancer care and referral center in India. Methods This study is a single tertiary center experience on COVID-19 in children with cancer and continuation of cancer-directed therapy in them. Children ≤ 15 y on active cancer treatment detected with COVID-19 until September 15 th , 2020 were prospectively followed up in the study. Patients were managed in accordance with well-laid guidelines. Treatment was continued for children with COVID-19 who were clinically stable and on intensive treatment for various childhood cancers. Results One hundred twenty-two children (median age 8 y; range 1–15 y, male:female 1.7:1) with cancer were diagnosed with COVID-19. Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%), and 6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35, and 60 d from diagnosis of COVID-19, respectively. Scheduled risk-directed intravenous chemotherapy was delivered in 70 (90.9%) of 77 children on active systemic treatment with a median delay of 14 d (range 0–48 d) and no increased toxicities. All-cause mortality rate was 7.4% ( n = 9) and COVID-19 related mortality rate was 4.9% ( n = 6). One hundred-fifteen (94.2%) children with COVID-19 did not require any form of respiratory support during the course of infection. Conclusions COVID-19 was not a major deterrent for the continuation of active cancer treatment despite persistent RT-PCR positivity. The long-term assessment of treatment adaptations requires further prospective follow-up and real-time addressal.

Continuing Cancer-Directed Therapy in Children with COVID-19 Infection—Adopting Newer Strategies?

“…It is pertinent to note that, although majority of children (94.2%) had only mild disease, COVID-19-related mortality in this cohort was 4.9%, which is relatively higher than that observed in children in general [3]. This reiterates the need for adopting newer strategies to limit the infection in this vulnerable cohort of children.…”

“…Yet, systematic studies of impact of COVID-19 infection and treatment disruptions on cancer care of children are few, especially in resource-constrained settings. In this issue of the Journal, the study by Parambil et al provides an important snapshot of experience of managing COVID-19 infection among children with cancer along with strategies for treatment adaptations [3].…”

“…We observe that the authors [3] have serially monitored for viral clearance by reverse-transcriptase-polymerase chain reaction (RT-PCR) assay in all patients, although the relevance of such practice on subsequent decision on treatment reinitiation is questionable. Indeed, treatments were reinitiated in clinically stable patients 1 wk from RT-PCR positivity irrespective of viral clearance without any adverse effect.…”

“…While, immunosuppression due to cancer-directed therapy reflected by lower nadir absolute neutrophil count (ANC) may be responsible for delayed RT-PCR negativity, it is unclear why delayed viral clearance was observed among children with higher baseline ANC; steroid use or type of malignancy did not affect viral clearance [3]. Further studies on immunogenicity following COVID-19 infection among children with cancer, based on type of cancer and antineoplastic therapy, need to be conducted systematically.…”

Clinical Course of COVID-19 Disease in Children Treated With Neoplastic Diseases in Hungary

“…In contrast to these findings, a Turkish investigation reported on a dramatic decrease in the number of both de novo diagnosed and treated pediatric cancer patients [ 18 ]. Participants of the St Jude Global Alliance and International Society for Paediatric Oncology survey also reported on a reduction of newly diagnosed patients and gross interruptions, even complete abandonment of anticancer therapies delivered [ 19 – 21 ]. According to this group of investigators, severe and critical conditions of COVID-19 were observed in one fifth of patients and deaths occurred in a higher proportion than were reported in the literature surveying the general pediatric population.…”